WO2010089699A2 - Fantôme pour perfusion en tomographie - Google Patents

Fantôme pour perfusion en tomographie Download PDF

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Publication number
WO2010089699A2
WO2010089699A2 PCT/IB2010/050475 IB2010050475W WO2010089699A2 WO 2010089699 A2 WO2010089699 A2 WO 2010089699A2 IB 2010050475 W IB2010050475 W IB 2010050475W WO 2010089699 A2 WO2010089699 A2 WO 2010089699A2
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Prior art keywords
perfusion
healthy tissue
blood perfusion
phantom
healthy
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PCT/IB2010/050475
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English (en)
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WO2010089699A3 (fr
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Jacob Sosna
Aviv Hirschenbain
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Hadasit Medical Research Services And Development Ltd.
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Priority to US13/147,378 priority Critical patent/US8636411B2/en
Publication of WO2010089699A2 publication Critical patent/WO2010089699A2/fr
Publication of WO2010089699A3 publication Critical patent/WO2010089699A3/fr
Priority to US14/139,894 priority patent/US8804904B2/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/504—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of blood vessels, e.g. by angiography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/58—Testing, adjusting or calibrating thereof
    • A61B6/582—Calibration
    • A61B6/583—Calibration using calibration phantoms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/484—Diagnostic techniques involving phase contrast X-ray imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/507—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for determination of haemodynamic parameters, e.g. perfusion CT
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
    • G01R33/00—Arrangements or instruments for measuring magnetic variables
    • G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
    • G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
    • G01R33/48—NMR imaging systems
    • G01R33/54—Signal processing systems, e.g. using pulse sequences ; Generation or control of pulse sequences; Operator console
    • G01R33/56—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution
    • G01R33/563—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution of moving material, e.g. flow contrast angiography
    • G01R33/56366—Perfusion imaging

Definitions

  • the present invention relates to improving therapy and drug tailoring in oncology patients, and, more particularly to improving the reliability of computed tomography ("CT") examinations measuring the effectiveness of the drug treatment in reducing cancerous tissue.
  • CT computed tomography
  • CT computed tomography
  • MRI magnetic resonance imaging
  • PET/CT PET/CT
  • CT machines although less sensitive for functional changes, have the advantage of being relatively cost-effective, not complicated, requiring only short examination time and there are a large number of available scanners.
  • FIG. 1 is a perfusion curve showing a combination of two curves, (i) wash-in of blood containing contrast material increasing exponentially and (U) wash-out of this blood containing contrast material decreasing logarithmically.
  • the actual perfusion, C the maximum attenuation point may be very sensitive to changes in A and B and this makes it a good measure to represent changes in overall perfusion in the tissue.
  • Techniques for calculating perfusion include the deconvolusion technique and the maximal slope technique.
  • the variables obtained with either technique may be influenced by external and internal factors not reflecting changes in the true tissue perfusion rate. Accordingly, when the perfusion rate may be re-measured at the second CT examination, factors that are unrelated to the true tissue perfusion and hence also unrelated to the value of the drug or treatment, distort the comparison of blood perfusion values required to perform drug tailoring.
  • the factors influencing the maximum attenuation point include external factors such as injection rate, contract dose and concentration, machine calibration, stability of the x-ray tube, and more.
  • GE 5 Phillips, Toshiba and Siemens make most of the CT machines sold today.
  • Each of these different manufacturers employs different algorithms and methods to calculate the blood perfusion result from the imaging data obtained during the CT examination. Since the second CT examination may be performed by a different machine, the results will be unreliable.
  • One aspect of the present invention is directed to an apparatus useful for computed tomography imaging, comprising a phantom control reference, comprising a plurality of compartments, each compartment containing contrast material, the contrast material differing in density from one compartment to another throughout the plurality of compartments, the densities of the contrast material in the plurality of compartments forming a series of densities that corresponds to a density curve of blood perfusion of a healthy tissue; and a controller for positioning the compartments in a screening field of view of a CT machine so the CT machine can take a series of images of the compartments at a same examination time that the CT machine takes a series of CT images of the healthy tissue.
  • a further aspect of the present invention is directed to an apparatus useful for computed tomography imaging, comprising a phantom control reference comprising a pipe containing a fluid and capable of receiving an injection of the contrast material from an injector at a time that the injector injects the contrast material into a patient, the pipe having sections of varying diameter, the sections of known flow rate so that a varying density of contrast material throughout the sections of the pipe correspond to a blood perfusion curve of the contrast material in a healthy tissue of the patient as measured during a computed tomography examination.
  • a phantom control reference comprising a pipe containing a fluid and capable of receiving an injection of the contrast material from an injector at a time that the injector injects the contrast material into a patient, the pipe having sections of varying diameter, the sections of known flow rate so that a varying density of contrast material throughout the sections of the pipe correspond to a blood perfusion curve of the contrast material in a healthy tissue of the patient as measured during a computed tomography examination.
  • a still further aspect of the present invention is directed to a method of using computed tomography equipment to measure blood perfusion in a patient having a cancerous tissue, comprising measuring a blood perfusion of contrast material in the cancerous tissue and in healthy tissue in the patient at a first examination time using a particular piece of computed tomography equipment to obtain a first cancer/healthy perfusion ratio result; measuring a blood perfusion of the contrast material in a healthy tissue phantom at the first examination time using the particular piece of computed tomography equipment, the healthy tissue phantom having a known density curve selected to correspond to the blood perfusion of the healthy tissue to obtain a first phantom perfusion result; re-measuring a blood perfusion of the contrast material in the cancerous tissue and in the healthy tissue in the patient at a second examination time, using a second piece of computed tomography equipment, to obtain a second cancer/healthy perfusion ratio result; and re-measuring a blood perfusion of the contrast material in the healthy tissue phanto
  • a still further, aspect of the present invention is directed to a method of controlling for variability in measurements of healthy tissue blood perfusion for computed tomography imaging, comprising using a particular piece of computed tomography equipment, measuring at a first time a blood perfusion of contrast material in a healthy aorta in a patient while measuring a blood perfusion of the contrast material in a healthy tissue phantom having a known density curve selected to correspond to the blood perfusion of the healthy aorta to obtain a first phantom perfusion result; repeating the measurements at a later time for the patient using a second piece of computed tomography equipment; and normalizing the results of the measurement of the blood perfusion in the healthy tissue found using the second piece of computed tomography equipment by using a change, if any, between the first phantom perfusion result and the second phantom perfusion result.
  • FIG. 1 is a graph of blood perfusion showing Pmax and a slope from base to peak enhancement
  • FIG. 2 is a photo of an apparatus comprising a phantom control reference, in accordance with one embodiment of the present invention
  • FIG. 3 is a front view of a tube in a phantom control reference, in accordance with one embodiment of the present invention
  • FIG. 4 is plan view of a phantom control reference in accordance with a further embodiment of the present invention
  • FIG. 5 is a flow chart showing a method in accordance with one embodiment of the present invention.
  • FIG. 6 is a flow chart showing a method in accordance with a further embodiment of the present invention.
  • the present invention generally provides more reliable blood perfusion measurements in computed tomography that may typically be used for drug tailoring in the early stages of cancer.
  • computed tomography may typically be used for drug tailoring in the early stages of cancer.
  • an apparatus representing a phantom control reference may be positioned in the field of view of the CT machine.
  • the apparatus may comprise compartments containing contrast material in differing densities that may cumulatively correspond to a density curve of blood perfusion of the healthy tissue.
  • a controller positions the compartments so the CT machine can scan them at a same examination time that the CT machine takes a series of CT images of the healthy tissue.
  • a phantom control reference may comprise a pipe having water that can receive an injection of the contrast material from an injector at the same time the injector injects the contrast material into a patient. Since the pipe may have sections of varying diameter and of known flow rate, the varying density of contrast material throughout the sections of the pipe may correspond to a blood perfusion curve of the contrast material in a healthy tissue of the patient as measured during a CT examination.
  • the method and apparatus of the present invention may provide a signficantly more stable and accurate measurement of blood perfusion using CT machines.
  • the CT method and apparatus of the present invention may be able to do so.
  • the CT method and apparatus o fthe present invention may allow devisvation of changes in days.
  • the method and apparatus of the present invention may allow a conclusion of effectiveness fo a drug after only a much smaller reduction in blood perfusion is found (in some cases, for example, 20%, 25% or 30%) because the results may be more reliabele.
  • the method and apparatus of the present invention may allow use of any CT machine available without having to be concerned that variations in machine manufacturers will interfere with the reliability of results.
  • the present invention may successfully control for variability of results pertaining to external factors such as injection rate, contract dose, concentration, machine calibration, stability of the X-ray tube, and internal factors such as size and condition of the IV, changes in heart rate and cardiac output.
  • the number of slides needed in a CT examination in order to be able to calculate blood perfusion may be approximately 12, which exposes the patient to radiation during that time
  • the number of slides may be reduced (e.g. to 6) and the length of exposure to potentially harmful radiation may also be reduced.
  • computed tomography imaging means imaging using computed tomography.
  • a phantom control reference 10 in its most general sense, may be anything that may contain contrast material of known densities corresponding to a density curve of blood perfusion of the healthy tissue of a patient that can be scanned in the field of view of a computed tomography (CT) machine while the patient's healthy tissue is also being scanned, and as to which an output can be obtained from the CT machine representing a density curve of blood perfusion for the phantom control reference.
  • Phantom control reference 10 may be external to the patient's body. At around the same time an output may be obtained for the phantom control reference, the CT machine may provide an output for the blood perfusion of the healthy tissue and for the cancerous tissue of the patient.
  • One way of constructing a phantom control reference is to have comprise a plurality of compartments 20, each compartment 2OA, 2OB, 2OC, 2OD, 20E, 2OF, 20G, 2OH, 201, 20J, 2OK, 2OL may contain contrast material differing in density from one compartment to another throughout the plurality of compartments.
  • the densities of the contrast material in the plurality of compartments are known densities, and together they may form a series of densities that corresponds to a density curve of blood perfusion of a healthy tissue as measured by a CT machine.
  • the number of compartments in the plurality may match the number of slices of CT images taken of the healthy tissue.
  • a controller would be used to position the compartments in a screening field of view of the CT machine so the CT machine can take a series of images of the compartments at a same examination time that the CT machine takes a series of CT images of the healthy tissue. More particularly, the controller may repeatedly and automatically position the compartments in a pre-defined spatial relationship.
  • one way of constructing the apparatus comprising a phantom control reference 10 is to have a wheel 20 that may have a series of test tubes 25 on a periphery 22 of wheel 20.
  • the test tubes contain known varying densities of a contrast material in a fluid such as water or another low denisty fluid.
  • the series of densities of the contrast material in the series of test tubes may form a density curve corresponding to a density curve measuring blood perfusion of a healthy tissue, as measured by a CT machine.
  • test tube wheel 20 sitting on a CT table may be consecutively rotated by a motor 30, motor 30 operatively engaged to a gearbox 31, so that each test tube 25 in the series of test tubes 25 on wheel 20 is successively positioned into a field of view of the CT imaging scan, of a CT machine while the same CT machine is scanning various slices of the patient's healthy tissue.
  • a controller 36 may direct motor 30 to rotate at speed so as to synchronize its rotation and positioning of test tubes 25 with the series of scans taken by the same CT machine of the patient's healthy tissue.
  • Reduction gear box 31 may reduce motor speed.
  • a reduction gearbox output may actually drive the test tube wheel 20.
  • the perfusion phantom robot may set the position of test tubes 25 according to a predefined program so that imaging results of test tubes 25 may be aggregated to form coordinates of a density curve as directed by software.
  • Apparatus 10 may be constructed so as to contain X- ray attenuation materials in order to reduce image artifacts and to achieve densities that are seen in clinical imaging.
  • the test tube wheel 20 may be held stationary and software 37 within controller 36 may be used to direct the CT machine to image successive test tubes within the wheel at a series of time intervals.
  • FIG. 2 also shows an X-ray detector 75 whose purpose is to ensure that the movement of the phantom control reference 10 will occur at times when there is no influx of photons to the detector.
  • the phantom reference control may be selected to result in a known density and a known series of densities. Notwithstanding this, the actual measured perfusion result of the healthy tissue phantom may vary from examination to examination due to external factors such as differences in CT machines, the different logarithms used by different brands of CT machines and the difference performances of different CT machines on different days. Furthermore, the selection of what the density curve of the healthy tissue phantom should be may be targeted to falling within the range of density curves of healthy tissue from experience of practitioners in the field. Alternatively, the perfusion may be based on a previously measured blood perfusion of the specific healthy tissue of the specific patient being examined. It is noted that a common example of the healthy tissue is a healthy aorta. In accordance with FIG. 3, the compartments 20 may be separate sections 2OA, 20B 5
  • the tube 40 may be moved through the screening field of view of the CT machine by a controller 30A that may direct a motor 3OA to linearly move tube 40 so as to synchronize positioning of sections 20A- 20L with the series of scans taken by the same CT machine of the patient's healthy tissue.
  • the phantom control reference may also directly simulate flow rate, for example the flow rate of the contrast material or the flow rate of the liquid containing the contrast material.
  • FIG. 4 shows a phantom control reference that may comprise a pipe 50 containing a fluid 51.
  • Pipe 50 may be capable of receiving an injection of the contrast material (for example in a saline solution) from an injector 60 at the same time that injector 60 may inject the contrast material into a patient 55.
  • Pipe 50 may have sections 51a, 51b, 51c, etc., of varying diameter so that each of the sections has a known flow rate.
  • the series of varying densities of contrast material throughout the sections of pipe 50 may form a density curve that may correspond to a blood perfusion curve of the contrast material in a healthy tissue of the patient as measured during a computed tomography examination.
  • the number of sections in pipe 50 may correspond to the number of computed tomography images taken of the healthy tissue during a computed tomography examination.
  • phantom control reference of FIG. 4 may also be suitable for use in MRI imaging in a manner similar to that described herein with respect to CT imaging.
  • an output structure 65 connected to the CT machine may provide a numerical blood perfusion result for the computed tomography images of the phantom control reference.
  • the output structure 65 may function like the output of a regular CT machine in providing blood perfusion results.
  • the present invention may also be expressed as a method, for example a method of using computed tomography equipment to measure blood perfusion in a patient having a cancerous tissue.
  • method 100 may comprise a step 110 of measuring a blood perfusion of contrast material in the cancerous tissue and in healthy tissue in the patient at a first examination time using a particular piece of computed tomography equipment to obtain a first cancer/healthy perfusion ratio result.
  • the output structure may provide the first cancer/healthy perfusion ratio result in a form commonly used for measuring blood perfusion. For example, ⁇ HU t j SS ue %&& ⁇ HU art ery rnay be obtained and placed into the following equation, which is one of two commonly used equations for calculating blood perfusion:
  • CBV stands for the calculated blood volume and is equal to changes in density of the tissue over that of the artery multiplied by the number of measurements.
  • the other commonly used equation for calculating blood perfusion is
  • a further step 120 of method 100 may comprise measuring a blood perfusion of the same contrast material in a healthy tissue phantom at the same first examination time using the same piece of computed tomography equipment.
  • the healthy tissue phantom may be initially designed to have a known density curve that may correspond to the blood perfusion of the healthy tissue in order to obtain a first phantom perfusuon result.
  • the word “correspond” may be understood to refer to an estimate rather than an exact match. That is, it may be that the healthy tissue phantom need not be initially selected to have the same identical blood perfusion as the healthy tissue. It may be merely selected to roughly estimate the healthy tissue blood perfusion to facilitate the normalization steps described below.
  • One way of selecting the level of blood perfusion desired for the healthy tissue phantom may be to use a prior known blood perfusion result for the same patient's kown from some previous examination, although this is not required and may not be available in certain cases.
  • the words “density curve” shall be understood to refer broadly both to a density curve as well as to a blood perfusion curve that may be derived directly from a contrast material's flow rate rather than from measurement of its density.
  • the output structure may produce a first phantom perfusion result that may be in a form of measurement of blood perfusion commonly used.
  • a still further step 130 of method 100 may involve re-measuring the blood perfusion of the contrast material in the cancerous tissue and in the healthy tissue in the patient at a second examination time. This may be done using a second piece of computed tomography equipment, to obtain a second cancer/healthy perfusion ratio result.
  • Method 100 may include a further step 140 of re-measuring the blood perfusion of the contrast materia! in the healthy tissue phantom at the second examination time using the second piece of computed tomography equipment to obtain a second phantom perfusion result.
  • the re-measuring for the healthy tissue and cancerous tissues in the patient and in the healthy tissue phantom may also occur at further examination times such as a third, fourth, fifth etc. examination time, as medically indicated.
  • Method 100 may be further extended to also include steps of (i) calculating a change between the first phantom perfusion result and the second phantom perfusion result to obtain a phantom variability; (ii) calculating a change in blood perfusion in the healthy tissue between the first examination time and the second examination time; (iii) normalizing the change in blood perfusion in the healthy tissue between the first examination time and
  • the second examination time Io reflect the phantom variability and to obtain a normalized healthy tissue perfusion reflecting healthy tissue blood perfusion conditions at the second examination time; (iv) calculating the second cancer/healthy perfusion ratio result by using the normalized healthy tissue phantom to remove contribution attributable to cardiac output and (v) calculating a relationship between the first cancer/healthy perfusion ratio result and the second cancer/healthy perfusion ratio result to obtain a true perfusion result.
  • This true perfusion result for the cancerous tissue may achieve a reliability that may be sufficiently high to allow a determinatioon of drug effectiveness in tumor reduction after only a 25% reduction has been found.
  • the number "25%” is merely a non-limiting example of a percentage signficantly lower than the conventional "50% yardstick often required before finding that a drug is effective in tumor reduction for a given individual.
  • the measurement slices over time of the first cancer /healthy perfusion ratio result may be made to coincide with the measurement slices over time of the first phantom perfusion result.
  • the measurement slices over time of the second cancer/healthy perfusion ratio result may be made to coincide with the measurement slices over time of the second phantom perfusion result.
  • the phantom measurements may be taken at the same time as the healthy and tumor measurements, but each slice of the phantom measurmenet may conicide with each slice of the healthy/tumor measurment.
  • the present invention may also be expressed as a method 200 of controlling for variability in measurements of healthy tissue blood perfusion for computed tomography imaging.
  • Method 200 may be comprised of a step 210 of measuring at a first time, using a particular piece of computed tomography equipment, a blood perfusion of contrast material in a healthy tissue (i.e. aorta) in a patient while measuring a blood perfusion of the contrast material in a healthy tissue phantom having a known density curve selected to correspond to the blood perfusion of the healthy tissue to obtain a first phantom perfusion result.
  • Method 200 may further include a step 220 of repeating the measurements (of the healthy tissue as well as that of the blood vessel phantom) at a later time for that patient using a second piece of CT equipment (or a third time using a third piece of CT equipment, etc.).
  • Method 200 may also include a step 230 of normalizing the results of the measurement of the blood perfusion in the healthy tissue found using the second piece of CT equipment by using a change, if any, between the first phantom perfusion result and the second phantom perfusion result. This may factor out a contribution attributable to cardiac output variability.
  • Method 200 may also include a further step of normalizing the results by conforming a percentage change in blood perfusion in the healthy tissue from a first examination time to a second examination time to a percentage change between the first phantom perfusion result and the second phantom perfusion result.
  • Method 200 may also be extended to include steps of (i) measuring a blood perfusion of contrast material in cancerous tissue of the patient each time the blood perfusion of contrast material in the healthy tissue may be measured; (ii) calcuating a ratio of blood perfusion between the cancerous tissue and healthy tissue for the first time; (iii) calcuating a ratio of blood perfusion between the cancerous tissue and healthy tissue for the later time by using the normalized results of the blood perfusion in the healthy tissue; and (iv) calculating an amount of reduction in cancerous tissue in the patient between the first time and the later time by comparing the ratio of blood perfusion for the first time with the already normalized ratio of blood perfusion for the later time.
  • Method 200 may allow normalizing the results to take out contribution from changes in the patient's cardiac output and from changes in the particular computed tomography machine used. It should be understood that the phrases “changes in the CT” used, “changes in CT machines”, “using a different CT machine” or CT equipment and the like refer both to changes in the physical machine selected to conduct the CT examination and to changes in the algorithm used by the machine.
  • Blood perfusion results may be obtained in the form of a curve having a measurable maximum height (Pmax) and slope (rate of change from baseline to peak enhancement MaxP per second).
  • Example 1 illustrates the application of the method and apparatus of the present invention.
  • a patient may be injected with a solution containing a contrast material, for example iodine, at time A for a CT examination and the flow of the contrast material through the cancerous tissue and through the healthy aorta (control tissue) of the patient is observed and Imaged by a particular piece of CT equipment during the CT examination.
  • a contrast material for example iodine
  • the patient is asked to come back for a follow-up CT examination at time B 5 which in one non-limiting example might be an examination time approximately one day, one week or one month (or any other shorter or longer time interval) later than the examination time for time A.
  • time B the same patient's blood perfusion measurement was X/4, which indicates a 20% lower reading for the healthy tissue.
  • X/4 the same patient's blood perfusion measurement was X/4, which indicates a 20% lower reading for the healthy tissue.
  • the units that the slope is expressed in have been omitted in this example, the actual units are in fact HU per second, where "HU" stands for Hounsfield units.
  • a healthy tissue phantom in accordance with one of the embodiments of the present invention was simultaneously being examined by the same CT machine examining the patient.
  • the blood perfusion results of this healthy tissue phantom may have been obtained at time A and at time B when the results of the patients tumor and healthy aorta were obtained.
  • the blood perfsuion results for the healthy tissue phantom were in this example found to be 5 (five) at time A and were found to be 4.6 at time B. Instead of the 20% reduction found for the patient's healthy tissue (which may be the aorta), an 8% reduction was observed.
  • the changes in the patient's cardiac output appear to have accounted for 0.6 of the 1.0 reduction (from 5 to 4) of the aorta blood perfsuion (i.e. 12 of the 20%).
  • the other 0.4 reduction i.e. 8 of the 20% appears to have been accounted for by external factors which were experienced by both the healthy tissue (aorta) and the healthy tissue phantom control reference since the phantom control reference does not experience cardiac output fluctuations but does experience fluctuations due to use of different CT machines and/or use of different CT machine algorithms.
  • a measurement of the healthy tissue phantom was set in advance to be "5" in the above example by designing a healthy tissue phantom to have such a slope. That slope may have been selected because the slope magnitude of "5" may be a reasonable estimate of healthy tissue blood perfusion in an adult patient. This may be based on prior CT examinations of other healthy tissue of other patients or it may be based on the results of this patient's prior examinations of their healthy aorta. In either case, the whole point of using the phantom is to have a control reference whose density curve or blood perfusion curve may be of known quantity.
  • the normalization of the results of the blood perfusion in the healthy tissue would involve substituting 4.6 for 4 as the arterial blood perfusion at time B in the equations.
  • the denominator healthy tissue blood perfusion
  • the denominator used will be the normalized denominator of helthy tissue blood perfusion.
  • a normalized cancer/healthy perfusion ratio will be obtained fo rthe second or later time (time B). Accordingly, when calculating the reduction o fthe tumor from time A to time B, cardiac output variability in the healthy tissue may not skew the results.
  • the patient's blood perfusion in cancerous tissue and in healthy tissue as measured by the particular piece of CTequipment is found to be X/6 at time A.
  • the same patient was re-measured at a follow-up CT examination at time B.
  • the patient's healthy tissue blood perfusion measurement at time B was found to be X/3, which represents a decline of 50% in blood perfusion of the healthy tissue between time A and time B. This means the healthy tissue was found to be (six) 6 at time A and found to be (three) 3 at time B.
  • a healthy tissue phantom in accordance with one of the embodiments of the present invention was simultaneously being examined by the same CT machine examining the patient.
  • the blood perfusion results of this healthy tissue phantom may have been obtained at time A and at time B when the results of the patients cancerous tissue and and healthy aorta were obtained.
  • the healthy tissue phantom at time A was found to be 5 (five) and the healthy tissue phantom at time B was found to be 4 (four), which represents a decline of 20%.
  • the blood perfusion of the healthy tissue phantom at time A is not the same as that of the healthy tissue at time A.
  • example 2 we may conclude that 20 of the 50% decline in healthy tissue results appears to have been due to using a different machine/algorithm and the remaining 30 of the 50% appears to have been due to cardiac output variability (i.e. decline) from time A to time B. Accordingly, using the method of the present invention we may normalize the healthy tissue perfusion at time B from (three) 3 units to 4.8 units. When calculating the ratio of cancerous tissue perfusion to healthy tissue perfusion at time B, we may normalize the ratio by substituting a 20% decline for the 50% decline in healthy tissue blood perfusion in the denominator of the ratio. In this case the X/3 ratio would be normalized to X/4.8.
  • the observed change in the healthy tissue phantom control reference was less than the observed change in the healthy tissue, which is what may be typical. It could happen, on the other hand, that the measured change in the healthy tissue phantom may be more than the measured change in the aorta because of a change in cardiac output in the other direction
  • the measured change in the healthy tissue phantom may be more than the measured change in the aorta because of a change in cardiac output in the other direction
  • a healthy tissue phantom in accordance with one of the embodiments of the present invention was simultaneously being examined by the same CT machine examining the patient.
  • the healthy tissue phantom at time A was 5 (five) and at time B it was 4 (four), which represents a decline of 20%.
  • the decline of (twenty) 20% observed in the phantom control reference for the healthy tissue may be assumed to be caused by the use of a different machine and/or machine algorithm.
  • the patient's cardiac blood perfusion was observed to have gone down less than that observed in the healthy tissue phantom. It may be concluded regarding the healthy tissue blood perfusion that cardiac output actually went up (ten) 10% between time A and time B and it may be further concluded that the relatively small 10% increase in cardiac output was more than counterbalanced by a larger 20% decline caused by switching to the different CT machine (or algorithm).
  • cardiac output actually went up (ten) 10% between time A and time B
  • the relatively small 10% increase in cardiac output was more than counterbalanced by a larger 20% decline caused by switching to the different CT machine (or algorithm).
  • one was able to observe a decline of (ten) 10% in the healthy tissue blood perfusion during the period from time A to time B. This may be captured by the simple equation 20-10-10.
  • the cancer to healthy tissue perfusion ratio may be normalized at time B from X/5.4 to X/4.8. In this case, one may adjust downward when factoring out a cardiac output increase. A determination of the reduction, if any, in the tumor blood perfusion attributable to factors other than cardiac output variability and other than use of different CT equipment may be made by comparing the ratio in time A with the normalized ratio in time B.

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Abstract

La présente invention concerne une référence physique fantôme servant à contrôler la variabilité des résultats de mesure par tomographie et dupliquant la courbe de densité de la perfusion sanguine d'agent de contraste dans une aorte saine ou dans une grande artère, afin de normaliser les changements observés dans la perfusion de sang artériel sain lors du calcul de la diminution de la perfusion sanguine d'une tumeur entre deux périodes d'examen. Dans un mode de réalisation, une pluralité de compartiments possédant différentes concentrations d'agent de contraste correspondant à une courbe de densité de la perfusion sanguine d'un tissu sain est positionnée dans un champ de criblage d'une machine de tomographie, permettant à la machine de tomographie d'imager les compartiments lorsqu'elle image les tissus sains. Dans un autre mode de réalisation, une conduite contenant un fluide reçoit une injection d'agent de contraste provenant de l'injecteur lorsque l'injecteur injecte l'agent de contraste au patient, la conduite possédant des sections de diamètre variable telles que les sections, ensemble, correspondent à une courbe de perfusion sanguine d'agent de contraste dans un tissu sain.
PCT/IB2010/050475 2009-02-03 2010-02-03 Fantôme pour perfusion en tomographie WO2010089699A2 (fr)

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US13/147,378 US8636411B2 (en) 2009-02-03 2010-02-03 CT perfusion phantom
US14/139,894 US8804904B2 (en) 2009-02-03 2013-12-24 CT perfusion phantom

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US14937109P 2009-02-03 2009-02-03
US61/149,371 2009-02-03

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US14/139,894 Continuation US8804904B2 (en) 2009-02-03 2013-12-24 CT perfusion phantom

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Also Published As

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US8636411B2 (en) 2014-01-28
US20110288406A1 (en) 2011-11-24
US20140114176A1 (en) 2014-04-24
US8804904B2 (en) 2014-08-12
WO2010089699A3 (fr) 2010-09-30

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